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Hypertension in Seniors & Isolated Systolic Hypertension (ISH)

Hypertension occurs in more than two-thirds of individuals after age 65. This is also the population with the lowest rates of blood pressure control. Treatment recommendations for older people with hypertension, including those who have isolated systolic hypertension, should follow the same principles outlined for the general care of hypertension.

In many individuals, lower initial drug doses may be indicated to avoid symptoms; however, standard doses and multiple drugs are needed in the majority of older people to reach appropriate blood pressure targets.

A common form of high blood pressure in older adults is isolated systolic hypertension (ISH).

ISH is high blood pressure, but only the top (systolic) number is high (140 or higher). ISH can be as harmful as high blood pressure in which both numbers are high.

ISH is the most common form of high blood pressure for older Americans. About 2 out of 3 people over age 60 with high blood pressure have ISH.

You may have ISH and feel fine. As with other types of high blood pressure, ISH often causes no symptoms. To find out if you have ISH--or any type of high blood pressure--get your blood pressure checked.

If not treated, ISH can cause damage to your arteries and to body organs. ISH is treated the same way as high blood pressure in which both systolic and diastolic pressures are high: by making changes in your health habits and with blood pressure medicines, if needed.

In patients with hypertension and stable angina pectoris, the first drug of choice is usually a beta-blocker; alternatively, long-acting calcium channel blockers can be used. In patients with acute coronary syndromes (unstable angina or myocardial infarction), hypertension should be treated initially with beta-blockers and ACEIs, with addition of other drugs as needed for blood pressure control. In patients with postmyocardial infarction, ACEIs, beta-blockers, and aldosterone antagonists have proven to be most beneficial. Intensive lipid management and aspirin therapy are also indicated.

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